Question

Acute Lymphocytic Leukemia

A father brings in his 3-year-old son, James, who was initially running a fever. He was given Tylenol, and the fever went away for 2 days. Now, however, the fever is back, and he has noted dark spots on his body and a lump in his armpit. He has been lethargic and has not wanted to eat for the last 24 hours. The physician suspects acute lymphocytic leukemia and has ordered blood chemistry studies, immunophenotyping, and bone marrow aspiration and biopsy.

The father is upset and wants to know what is leukemia and how did his son catch it? How would the nurse address this question?

The nurse arranges to have laboratory tests drawn and schedules the immunophenotyping and bone marrow aspiration and biopsy. Discuss the importance of these tests.

Is there a possibility that leukemia has spread in the body?

What treatments are available for leukemia?

Answer 1

1st question:

The cause of acute lymphocytic leukemia is multifactorial. That means more than one factor is responsible for the development of the ALL. The risk factors for ALL are:

1. Prenatal exposure to X-rays
2. Post-natal exposure to radiation
3. Exposure to high levels of chemicals like benzenes, chloramphenicol, Arsenic
4. Certain genetic syndrome:
   1. Down's syndrome
   2. Klinefelter syndrome
   3. Ataxia-telangiectasia
   4. Bloom syndrome
   5. Neurofibromatosis
5. Severe congenital neutropenia
6. Inherited genetic polymorphism
   1. GATA3
   2. rs3781093
   3. MMP-8 promoter
7. RNA viruses - (HTLV - 1)

The widely accepted process of development of ALL is the two step process

• The first injury occurs in utero ( antenatal life). This gives rise to pre-leukemia clones
• The second injury occurs in the post natal life. If a child isn't expose to injections early in life or a higher level of hygiene is maintained during the child early days (as it occurs in affluent nations), the body's immunity is abnormally regulated.

2nd question:

• Bone marrow aspiration and biopsy is done to obtain definitive diagnosis of ALL
• Immunophenotying helps to identify subtype.

3rd question:

60% risk of CNS metastasis

4rth question:

• The treatment consist of chemotherapy and CNS prophylaxis
• Induction phase I- Prednisolone, vincristine, daunorobicin, L-asparaginase
• Induction phase II - Cyclophosphomide, cytarabine, 6-mercaptopurine
• CNS prophylaxis consist of intrathecal chemotherapy and concurrent cranial irradiation.